Description

Brown identified risk factors for hypotension in a patient experiencing a generalized hypersensitivity reaction. These can help identify a patient who may require more aggressive management. The author is from Royal Hobart Hospital in Australia.


 

Patient-specific factors associated with an increased risk for hypotension:

(1) age >= 40 years

 

Features of a hypersensitivity reaction associated with hypotension:

(1) incontinence

(2) collapse or loss of consciousness

(3) diaphoresis (sweating)

(4) cyanosis or decreased oxygen saturation (<= 92% on room air)

(5) vomiting

(6) dizziness

(7) dyspnea

(8) nausea

 

where:

• Incontinence, collapse and cyanosis/(decreased oxygen saturation) are markers of a severe reaction, while the other 5 factors are associated with a moderate reaction.

• The odds ratio for incontinence is 13. The odds ratios for the other factors range from 2.1 to 3.8

• Cardiovascular comorbidities, ACE inhibitors, and beta blockers were not found to be associated with severe reactions or death in multivariate analysis.

 

For the implementation I have tried the following scheme to capture this information.

 

Parameter

Finding

Points

incontinence

present

2

 

absent

0

age of the patient

>= 40

1

 

< 40

0

collapse or loss of consciousness

present

1

 

absent

0

diaphoresis

present

1

 

absent

0

cyanosis or decreased oxygen saturation

present

1

 

absent

0

vomiting

present

1

 

absent

0

dizziness

present

1

 

absent

0

dyspnea

present

1

 

absent

0

nausea

present

1

 

absent

0

 

total score =

= SUM(points for all 9 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 10

 

Total Score

Risk of Hypoxia

0

low

1

low to moderate

2

moderate to high

3

high

4 - 10

very high

 


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